Caregiver guide
Words That Land
Talking with someone living with dementia can feel like your words aren’t landing. You say something simple and get a puzzling answer, or a nod when you are not sure you have understood each other.
Often the problem isn’t what you say but how it arrives. Small changes in where you stand, how much you say, how long you wait and what you ask make a real difference. The 3D guide shows each moment twice: first from her side, then with one change.
What They Might Hear
Dementia can change how the brain makes sense of sound, even when hearing itself is fine. Speech that used to be easy to follow can arrive in pieces.
It takes longer to work out
Your loved one may need more time to process what you said. By the time they have, you may have said three more things.
Other sounds compete
A TV, a radio or two people talking at once make it much harder to pick out your voice. In studies, people with dementia do worse than their peers when two voices compete.
They act on the pieces
When only a few words land, your loved one may act on the words they caught. “Leaving” and “coat” can mean “go now.”
Faces fill the gaps
Seeing your face, lips and hands helps them follow. Talking from behind or from another room takes all of that away.
Rule out the fixable first: hearing aids in, switched on and working, glasses clean and on, and a hearing test if it’s been a while. Wax, an infection or hearing loss can make everything harder.
Say It So It Lands
Before you speak, set up the moment. These habits help in almost every conversation.
- Make it quiet. Turn off the TV or radio, or move somewhere calmer.
- Come to the front, at eye level, and say their name. Wait until they look at you.
- One idea per sentence, said slowly and in the order it will happen: “Lunch first.” Later, “Time for your coat.”
- Show as well as say. Hold up the coat, point to the cup, or write it down. Many people find written words easier to follow than speech.
- Use names instead of “he,” “she” or “it.”
- Keep your body language warm. Much of what you mean comes through your face and tone.
Give Them Time
An answer can take a while to form. A second question before the first one is answered starts the work over.
- Ask one question, then wait, longer than feels natural.
- Offer two choices instead of an open question, and show them: “Coffee or tea?” with both cups in view.
- A yes-or-no question is easier still: “Would you like some coffee?”
- Don’t rush to fill the silence or finish their sentence. If they’re stuck, gently offer the word they may be looking for.
- If they didn’t follow, say it again in shorter words.
When You Ask a Question
Many people living with dementia work hard to hide what they can’t remember. In one study of memory testing, more than half of people with Alzheimer’s gave answers that covered what they couldn’t recall. Some also turn to the person with them for help.
So a question that tests memory can feel like a quiz they’re failing, and the smooth answer you get may not be real. Put the answer inside the question instead.
| Instead of | Try |
|---|---|
| “Do you remember who called?” | “Ann called, your sister. She sends her love.” |
| “What would you like to drink?” | “Would you like some coffee?” |
| “What do you want to wear?” | “The blue sweater or the green one?” Hold both up. |
| “Remember when we went to the lake?” | “I remember when we went to the lake.” |
| “What did you do this morning?” | “I had a busy morning.” Talk about your day and about now. |
| “Do you know who I am?” | “Hi Mom, it’s Sarah.” |
Answer the Feeling
Sometimes your loved one will say something that isn’t true: they need to pick up the kids, or get to work. If it’s harmless, you don’t have to correct it. Correcting often doesn’t change what they believe, and the upset can last.
Feelings last longer than memories. In one study, people with Alzheimer’s forgot much of a sad or happy film within minutes but stayed sad or happy for up to half an hour. A hard moment can linger, and so can a kind one.
- Respond to the feeling, not the facts: “You always took such good care of them.”
- Reassure, then offer something to do together: “Could you help me dry these?”
- Talk as you would to any adult. Baby talk, like “Are we ready for our bath, sweetie?”, is linked to more resistance to care.
- If what they say is upsetting or unsafe, stay calm, comfort them, and gently change the scene.
Ask It Another Way
Pick a situation to see a common question beside one that’s easier to answer. Save the ones you want to remember. They’re kept only while this page stays open.
My phrases
Words that work for us
Tap Save on a phrase to keep it here, then copy or print the list for anyone who helps.
Talk to the doctor if hearing seems worse, or if misunderstandings become frequent or upsetting. A hearing check can rule out wax, an infection or hearing loss.
This guide offers general tips. Every person is different, and what helps can change over time. Your loved one’s doctor or care team can help you decide what is right for them.
Sources: Dementia UK, Difficulty with sounds · Dementia UK, Communication tips · Alzheimer’s Association, Communication and Alzheimer’s · Alzheimer’s Society, What not to say to somebody with dementia · Alzheimer’s Society, Changes in perception · Utoomprurkporn and others, 2020, hearing with competing speech in dementia · Matsushita and others, 2018, saving-appearance answers · Fukui and others, 2011, the head-turning sign · Guzmán-Vélez and others, 2014, feelings without memory · Williams and others, 2009, elderspeak and care · Strick and others, 2021, meaningful occupation